43-088 66 WHITTIER ST BP-2007-0251
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 43 -088 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-0251
Project# JS-2007-000384
Est.Cost: $37000.00
Fee: $154.25 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: GOUGEON & LOCKE 001992
Lot Size(sq. ft.): 59677.20 Owner: MARQUIS RICHARD J &KAREN L
Zoning: SR Applicant: GOUGEON & LOCKE
nT
Applicant Address: Phone: Insurance:
26 South Street (413) 268-9323 Workers
Compensation
WILL.IAMSBURGMA01096-9726 ISSUED ON:9/7/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:CONVERT GREENHOUSE TO SHED, INSTALL
REPLACEMENT WINDOWS, DOORS & SIDING,12/12/06 CONVERT DINING RM TO GUEST
ROOM. REMODEL KITCHEN
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough /2/ 47/9( House# Foundation:
Driveway Final:Final: x. Final: 2� 3/b
Rough Frame: k/ a -l` " d"G
of/Ad
Gas: Fire Dobartment Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: O 0 3 '0 2
7 .4„uts
THIS PERMIT MAY BE REVOKED BY TH ITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATION .
Certificate of •ccu•anc/ Si_nature:
FeeTvne: Date Paid: Amount:
Building 9/7/06 154 25
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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File#BP-2007-0251
APPLICANT/CONTACT PERSON GOUGEON&LOCKE
ADDRESS/PHONE 26 South Street WILLIAMSBURG (413)268-9323
PROPERTY LOCATION 66 WHITTIER ST
MAP 43 PARCEL 088 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out f/_ '
Fee Paid / '-I' 7e'`6v
Typeof Construction: CONVERT GREENHOUSE TO SHED,INSTALL REPLACEMENT WINDOWS,DOOZS
&SIDING 06
41111.41111111111111111111.1011111111.01.
New Cons
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 001992
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission
/J
j �—64 -€4, 402//Z/4.6
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Departm:nt
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
2006 Room 100 WaterNVell Availability
DEC 1 2 Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: . This section to be completed by office
W/titiir (St. Map Lot Unit
f`tr( e,(_ M i- 2 -- Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Pt d- k 1104401io W I i If1 c . Rl(ron.c.c.
Name(Print) ) Current Mailing Address:
C ✓ /l Telephone
Signature Sec-5-
2.2 Authorized Agent:
o 1/ Sr. GueGlllrASO!/ r—
Name(Print) Current Mailing Address:
drd
�- 2-.6P- 73 Z3
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building / 2,1 (a) Building Permit Fee
2. Electrical � r n , (b) Estimated Total Cost of
I
J !- v Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) /
7�JUf�C/ ry
5. Fire Protection
6. Total = (1 +2+3 +4+5) /4 6 Check Number #94/7 L /ai 5O
This Section For Official Use Only
Building Permit Numb : Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existin Proposed Required by Zoning
rO A/ 1 t t�1/4"T�SY., This column to be filled in by
f v (/ l ✓J Building Department
Lot Size
Frontage ._ _ `� ��_.__
Setbacks Front LJ ..__..._w.,.
Side L: '....... . L:. R:[
Rear t
Building Height [ r
Bldg. Square Footage = % V_..
Open Space Footage %
(Lot area minus bldg&paved LJ
parking)
', 1
#of Parking Spaces
Fill:
(volume&Location) a
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW ere. YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW E ,J YES
IF YES: enter Book ^^„^_,,,,y Page a
B. Does the site contain a brook, body of water or wetlands? NO
IF YES, has a permit been or need to be obtained from the
Needs to be obtained Q Obtained 4111
C. Do any signs exist on the property? YES Q
IF YES, describe size, type and location: AIIIIIIIIIIIIIIIMIIMIIMIII
D. Are there any proposed changes to or .
MP
IF YES, describe size, type and
E. Will the construction activity dist
that will disturb over 1 acre?
IF YES,then a Northam
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [ID] Decks [Q Siding[CI] Other[O]
Brief Description of Proposed / �� /2 f /�� ��� ��/��� �+/ •
Work: /4,�i'V( /AV/Gis /11Ata , ti it ��(,�rAttx- i 7'L6r/l
�,��,/- ram, /e �
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes (/ No
Plans Attached Roll -Sheet
6a.if New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrpofns
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves _Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
PA 117e•0 Alt 1 V 1$ , as Owner of the subject
property �',/
hereby authorize JA$t,ES Leek-._
to act on my behalf, in all,matters rglative to work authorized by this building permit application.
C 2--4 /717
Signature of n r Date
J/ t't G� , as 8wner'Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
(1/4114
Print Name
/L-/`—lam
Signature of Owner/ nt Date
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: OD/9 9 2-
�� / /'/ ,',.p License Number
.r0 v � crjTh W JUM-X �O 0��- /Z - S • 07
Address Expiration Date
d6C � - �3z3
Signaturesigfil‘.1.4
Telephone
9.Registered Home imbrouement Contractor Not Applicable 0
Company Name GOUGFN & LOCKE Registration Number
26 South Street 6 -/2 - D
Address Williamsburg, MA 01096 Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 No 0
11. Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures a:cessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the uilding Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance wi,h the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
g' `_�� 1`E Grl2 cf Narf! <:iutpfoii 1 =-
-~ ,
DEPARTMENT OP BUILDING INSPECTION'S ill —
212 Main Street ' Municipal Building ‘ •
i Northampton, Mass. 01060
WORKER'S COMTENSATTON tj?SVivt.ttCE AI'i' TM\rLT
i
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��GO 3GEON Fa. LOCKS
Glccnsx)permittcc) f+V r.7 iil Sir t.. _....__._.—_.
v_hth 2 principal place of business/residence at: Williamsburg, MA 01096
(phone ) •
(so-txtici ty/wait.'=p)
do hereby certify, under the pains and penalties of perjury; but
( I am an employer providing the following worker's coinpcnsaDon covervge for my
•
employees worng on this job: 37sj I Lros
Assoc/ p,MPIwc iNs.ch . i Z - 6 -
(Insu.rn Company) (PcLic; NuL'.Zbc_r) (rspirtion Dan)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below wbo h.ave the following worker's c000entaaon policies:
(Isiemc of Co.^.tnIcior) (Insurance Company/Folic,- Numbs ) (r:ptr'duon Date)
(Name of Contractor) (Lns-w-ancc Compa.ayiPo!ic; Number) (E.vpiriion Date) ,
•
(Name of Connacio.) (Insuranc: Company/Podcy Numb.u) (Expirdon Date)
(Name of Contractor) (Insuranca Comr tny/Policy Numb-,;r) (Expiraiion Daic) .
(aa.ac,i' additio=d bcot if 0ccc1Z7,co..tuck infort:a.aoc pctiinia6 to.11 ooar-so:s) .
( ) I am a sole proprietor and have no one working for me.
( ) I am.a home owner performing all the work myself.
NOTE:PI—sc be.''''um,h..svbi.lo txmeu..-om„to crap Ioy pesoos In do rs%"--,—,m =r.;e.,00 c rccaa work as.dwr-11_,of
ant mote tbzo c=ara in with tb.bornoowocr rtzida or oo the crouoca tppurtenr_tbeen�z one ca.—zlly arid.-vi to bo
cxploycs"at-c the`.at c+,' c'- -+icn Act(GL152.n I(S)), .pplictioo by a boo .-oa for_!ic_or I,.s wit ray c.idmoc Lb.
IepJ ctaau or en ealoyer under tho WorF.or'a Compsmataoa ACC.
1 uodcrr.od dux a Dopy of this mica.=may b.for-a.evd.d to tba pep.nme t of 1.r..6•+-r;al Aoodrm'Otto.of Ira+r.00a for Lb.
covcra.,3c`criletioa and th t Elam to sccurc'covera.cc tsar+=:oGion 23 A of MOL 152 ma la.d to the impasitioa or oimiaal pewIua 1
ma of a floc or up to S 1 Soo.00.nr'Joe izaprisooza=of up to ooc ycr tax!civil pro.ilia io t x form o(a Stop Wort;Order and a l
rim o(s I O0.00 a day tpia2 coo.
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MA.-0t0%
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